‘Courses for Horses’: designing, adapting and implementing self practice/self-reflection programmes

2019 ◽  
Vol 12 ◽  
Author(s):  
Mark H. Freeston ◽  
Richard Thwaites ◽  
James Bennett-Levy
Keyword(s):  
Evidence Base ◽  
Therapist Development ◽  
List Type ◽  
Training Methods ◽  
Learning And Development ◽  
Self Reflection ◽  
Therapeutic Modalities ◽  
Potential Risks ◽  
Training Programmes ◽  
Supervisory Experience

AbstractSelf-Practice/Self-Reflection (SP/SR) has been proposed both as an adjunct to therapy training programmes, and also as a means for therapist development among experienced therapists. Research suggests it develops aspects of knowledge and skill that may not be addressed through other training methods. With increasing interest in SP/SR, a growing evidence base regarding both participant benefits and potential risks from SP/SR, and the development of SP/SR programmes across a range of therapeutic modalities, we argue it is timely to identify a set of principles that can guide the design, adaptation and implementation of SP/SR programmes. At this stage, there is little empirical evidence to guide trainers wishing to implement SP/SR in different contexts. Accordingly, these principles have been derived from reflection on developing, testing and implementing SP/SR programmes as well as on other training and supervisory experience. The first set of principles detailed in Section 1 draw on various theories of learning and development and frame the processes involved, the next principles speak to the content of SP/SR programmes, and the final principles address structure. Within Section 2, the principles are then considered for their practical implications. In Section 3, the sharing of what are initially private self-reflections is then considered together with some implications for SP/SR programmes, especially when there is assessment involved. We argue that SP/SR will continue to progress with well-designed standard programmes, careful implementation, thoughtful adaptation, ongoing innovation, and especially more evaluation.Key learning aims(1)To understand the principles for designing, adapting and implementing SP/SR programmes that are drawn from theory and from the authors’ experience of developing and implementing SP/SR programmes over the last 20 years.(2)To understand the possible factors that guide the processes, content and structure of SP/SR programmes.(3)To understand how best to maximize effective engagement and learning (and limit harm) when planning or implementing an SP/SR programme.

scholarly journals Psychodynamic psychotherapy: developing the evidence base

2014 ◽  
Vol 20 (4) ◽  
pp. 269-279 ◽  
Author(s):  
Jessica Yakeley
Keyword(s):  
Outcome Research ◽  
Psychodynamic Psychotherapy ◽  
Psychological Treatment ◽  
Psychotherapy Research ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Treatment Modalities ◽  
List Type ◽  
Therapeutic Modalities ◽  
Cognitive Behavioural

SummaryPsychodynamic psychotherapy has been criticised as being based on outdated principles of psychoanalysis and lacking an adequate evidence base to convincingly demonstrate its efficacy. This article summarises the recent evidence from high-quality outcome studies to show that psychodynamic psychotherapy is as effective in the treatment of a range of mental disorders as other psychological treatment modalities such as cognitive-behavioural therapy, as well as reviewing process-outcome research aiming to elucidate mechanisms of therapeutic change. A paradigm for psychodynamic psychotherapy research based on attachment theory is introduced, which may inform the development of psychodynamic therapeutic modalities tailored for specific conditions.LEARNING OBJECTIVESUnderstand the basic principles and techniques of psychodynamic psychotherapy.Be able to summarise the recent evidence base for the efficacy of psychodynamic psychotherapy.Appreciate process-outcome research that elucidates therapeutic mechanisms underpinning psychodynamic psychotherapy.

History and Personal Autonomy

1993 ◽  
Vol 23 (2) ◽  
pp. 271-280 ◽  
Author(s):  
Alfred Mele
Keyword(s):  
Personal Autonomy ◽  
The Self ◽  
Personal History ◽  
Individual Autonomy ◽  
List Type ◽  
Historical Account ◽  
New Model ◽  
Self Reflection

John Christman, in ‘Autonomy and Personal History,’ advances a novel genetic or historical account of individual autonomy. He formulates ‘the conditions of the [i.e., his] new model of autonomy’ as follows:(i) A person P is autonomous relative to some desire D if it is the case that P did not resist the development of D when attending to this process of development, or P would not have resisted that development had P attended to the process;(ii) The lack of resistance to the development of D did not take place (or would not have) under the influence of factors that inhibit self-reflection;and(iii) The self-reflection involved in condition (i) [sic] is (minimally) rational and involves no self-deception. (11)

scholarly journals Self-fill oxygen technology: benefits for patients, healthcare providers and the environment

Breathe ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Phyllis Murphie ◽  
Nick Hex ◽  
Jo Setters ◽  
Stuart Little
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Cost Effective ◽  
Evidence Base ◽  
Environmental Benefits ◽  
List Type ◽  
Potential Cost ◽  
Unlimited Supply ◽  
Technology Benefits

“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers.Educational aimsProvide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.

scholarly journals SSRI use in pregnancy: Evaluating the risks and benefits

2015 ◽  
Vol 21 (2) ◽  
pp. 6
Author(s):  
Elsa Du Toit ◽  
Eileen Thomas ◽  
Liezl Koen ◽  
Bavi Vythilingum ◽  
Stoffel Grobler ◽  
...  
Keyword(s):  
Antidepressant Treatment ◽  
Severe Depression ◽  
Evidence Base ◽  
Current Evidence ◽  
Benefit Analysis ◽  
Medication Effects ◽  
Current Evidence Base ◽  
Pregnancy And Lactation ◽  
Potential Risks ◽  
Risk Benefit Analysis

<p>Selective serotonin reuptake inhibitor (SSRI) antidepressants are considered the primary pharmacological treatment for moderate to severe depression during pregnancy.<span><em> </em></span>Data regarding the safety of their use during pregnancy remain controversial and conflicting. Decisions regarding the prescription of antidepressant treatment are often fraught with concern around potential harmful medication effects on the pregnancy, fetus and infant. Information on potential risks remains extremely varied and inconsistent across sources. This lack of clarity regarding drug safety brings significant uncertainty not only for treating physicians, but also for women seeking information about depression during pregnancy. This review aims to summarise and evaluate the current evidence base and to aid clinicians in performing a risk/benefit analysis for SSRI use during pregnancy and lactation.</p><div> </div>

scholarly journals Off-label prescribing of quetiapine in HMP Elmley, a Category B remand prison: a re-audit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S85-S85
Author(s):  
Nosa Igbinomwanhia ◽  
Kathleen McCurdy
Keyword(s):  
Mental Health ◽  
Royal College ◽  
Health Assessment ◽  
List Type ◽  
Physical And Mental Health ◽  
Off Label ◽  
The Past ◽  
Number Of Patients ◽  
Prescribing Practice ◽  
Potential Risks

AimsThis was a re-audit of off-label prescribing of quetiapine in order to identify the number of patients on off-label quetiapine in HMP Elmley, to monitor compliance by the Mental Health Inreach Team (MHIRT) psychiatrists with the Royal College of Psychiatrists guideline on off-license prescribing, to compare findings with the baseline audit and to identify areas for improvement.MethodAll patients on quetiapine in HMP Elmley were identified and their electronic patient record was reviewed against the standards outlined in the Royal College of Psychiatrists “Use of licensed medicines for unlicensed applications in psychiatric practice (2nd edition).ResultThere were 60 residents on off-license quetiapine prescription in HMP Elmley.Of this number, four had their prescription initiated by a general practitioner, either while in prison or in the community. Two residents were on quetiapine first prescribed while they were on admission in hospital. 5 patients had been initiated by the MHIRT psychiatrists. 38 residents were commenced off-license quetiapine by another psychiatrist, either while they were in the community or in another prison. In 17 patients, electronic records were inadequate to determine who had prescribed the quetiapine.The number of inmates prescribed off-label quetiapine in HMP Elmley had dropped from 82 to 60 in the 1 year since the initial audit. Of these figures, prescriptions initiated by the MHIRT psychiatrists, had dropped from 28.1% (23/82) to 8.3% (5/60).For those prescribed quetiapine by the HMP Elmley psychiatrists, notes were audited against the RCPsych guidelines: Licensed medication was considered first in 80.0%Risks and benefits were considered and documented in 80.0%The benefits and potential risks were explained to patient in 80.0%There was documentation of informed consent in 80.0%Quetiapine was started at a low dose and monitored in 100%No residents required withdrawal of medication due to ineffectiveness or adverse effects.Baseline physical health assessment was performed in 80.0%, though all had an ECG done.ConclusionOver the past year there has been an improvement in off-label antipsychotic prescribing practice within the MHIRT.However, the number of off-label antipsychotic prescriptions still remains high throughout the prison. There should be continued effort at minimizing off-label prescribing within the MHIRT, monitored by auditing. However, work needs to be done jointly with other prescribers, such as GP colleagues, in order to avoid unnecessary prescriptions and to monitor regularly the physical and mental health of those on off-label quetiapine.

scholarly journals Tailoring surgical interventions to treat obstructive sleep apnoea: one size does not fit all

Breathe ◽  
2018 ◽  
Vol 14 (3) ◽  
pp. e84-e93 ◽  
Author(s):  
Priya Sethukumar ◽  
Bhik Kotecha
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Evidence Base ◽  
Sleep Apnoea ◽  
Good Effect ◽  
Surgical Approaches ◽  
List Type ◽  
Drug Induced ◽  
Surgical Interventions ◽  
Obstructive Sleep ◽  
New Treatments

While continuous positive airway pressure (CPAP) remains the gold standard treatment of choice in patients with moderate or severe obstructive sleep apnoea (OSA), surgery has been established as a means to improve compliance and facilitate the use of CPAP, both of which are potential pitfalls in the efficacy of this treatment modality. In a minority of cases, with obvious oropharyngeal anatomical obstruction, corrective surgery may completely alleviate the need for CPAP treatment. In this review, we summarise clinical assessment, surgical options, discuss potential new treatments, and outline the importance of investigating and addressing the multiple anatomical levels that can contribute to OSA. Research into effectiveness of these procedures is rapidly accumulating, and surgery can be an effective treatment. However, given the myriad of options available and multiple levels of anatomical pathology that can present, it is imperative that correctly selected patients are matched with the most appropriate treatment for the best outcomes.Key pointsOSA is an increasingly prevalent disorder which has significant systemic effects if left untreated.Anatomical abnormalities can be corrected surgically to good effect with a growing and robust evidence base.Drug-induced sleep endoscopy is a key tool in the otolaryngologist's armamentarium to tailor specific surgery to address specific anatomical concerns, and to facilitate appropriate patient selection.Multilevel surgical approaches are often indicated instead of a “one size fits all” model.Educational aimsTo discuss how to assess patients presenting with OSA in clinic, from an otorhinolaryngology perspective.To discuss the indications for intervention.To provide an overview of nonsurgical interventions for treating OSA, with evidence.To discuss the different surgical modalities available for treatment of OSA, with evidence.

05 Co-design of a logic model describing components, mechanisms of change and expected impacts of case management for people who frequently call ambulance services

2021 ◽  
Vol 38 (9) ◽  
pp. A3.1-A3
Author(s):  
Rabeea’h Aslam ◽  
Robert Cole ◽  
Berni Diethart ◽  
Adrian Edwards ◽  
Bethan M Edwards ◽  
...  
Keyword(s):  
Case Management ◽  
Evidence Base ◽  
Professional Staff ◽  
Logic Model ◽  
Prehospital Emergency Care ◽  
Mechanisms Of Change ◽  
Clear Understanding ◽  
List Type ◽  
Management Approaches ◽  
The Uk

BackgroundMulti-agency case management is being introduced by ambulance services and their partners in the UK to try to identify and address the needs of those who call 999 ambulance services frequently. However, there is a lack of evidence about what works well in this setting and how. Based on current nationally agreed definitions, calling frequently is defined as 5 or more times in a month, or 12 or more times in a three-month period. The STRETCHED study (STRategies to manage Emergency ambulance Telephone Callers with sustained High needs – an Evaluation using linked Data) study seeks to evaluate clinical and cost-effectiveness, safety, and efficiency of case management for people who frequently call the emergency ambulance service.We developed a logic model to describe key components, mechanisms of change and expected impacts of cross-sectoral case management approaches to the management of people who call 999 frequently.MethodWe conducted a stakeholder event with 37 people from Wales, England and Northern Ireland including patient representatives and professional staff involved in commissioning, planning and delivering case management for people who call 999 services frequently. The aggregated responses from the participants was used as the basis for developing a logic model.ResultsComponents: dedicated staff time for case management, availability and knowledge of relevant services for referral, multidisciplinary collaboration, organisational support, and clear information sharing protocolsMechanisms: provision of space for a clear understanding of reasons for calling, tailoring of multi–sectoral management to individual needs, offering therapeutic support and assistance in development of self–efficacyImpacts: improvement in access to appropriate and timely care, increase in efficiency and accessibility of the healthcare system, reduction in emergency calls, costs and mortalityConclusionCase management is a developing area of provision in prehospital emergency care for people who call ambulance services frequently. Our logic model provides a firm foundation for evaluation to build the urgently needed evidence base for case management of people who call ambulance services frequently.

Behavioural couple therapy: measuring therapist competence

2020 ◽  
Vol 13 ◽  
Author(s):  
I. Rudolf von Rohr ◽  
S. Corrie ◽  
M.S. Fischer ◽  
D.H. Baucom ◽  
M. Worrell ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Content Validity ◽  
Couple Therapy ◽  
Formative Feedback ◽  
Face Validity ◽  
Future Research ◽  
List Type ◽  
Self Reflection ◽  
Therapist Competence ◽  
Two Stages

Abstract This paper outlines a pilot validation study of the newly developed Behavioural Couple Therapy Scale for Depression (BCTS-D). The BCTS-D aims to assess therapist competence in delivering behavioural couple therapy (BCT) and provide therapists with summative and formative feedback on their performance. Completed by both therapist and supervisor, this will aid therapists’ reflection on practice and improve performance. This paper will report on two stages in the development of the BCTS-D: (a) a study evaluating content validity, face validity and usability and (b) a focus group examining usability and utility. Both parts of the study were conducted in the context of a BCT training course and included 20 participants who were either BCT supervisors or BCT trainees. Results suggest that the BCTS-D has good face validity, content validity and usability, and provides a useful tool for promoting self-reflection and providing formative feedback. The studies also provided insight into the strengths of the scale and into areas of refinement, and a number of modifications were undertaken to improve the BCTS-D in response to feedback collected. Future research will need to focus on evaluating the psychometric properties of the BCTS-D and continue to adapt the scale to its users’ needs. Key learning aims (1) Readers will understand the importance of measuring therapists’ competence to improve practice. (2) Readers will understand the development of the BCTS-D scale and its initial psychometric properties. (3) Readers will know how to use the BCTS-D in everyday clinical practice. (4) Readers will know about the challenges of developing a therapist competence measure within a real-world clinical context.

scholarly journals P15 Using prescribing nudges to reduce medication errors: paracetamol on paediatric intensive care

2020 ◽  
Vol 105 (9) ◽  
pp. e13.2-e14
Author(s):  
Jenny Gray ◽  
Nicole Aubrey ◽  
Emma Hipkin ◽  
Nicholas Jones
Keyword(s):  
Medication Errors ◽  
Undergraduate Students ◽  
Reduction Rate ◽  
Traditional Education ◽  
Electronic Prescribing ◽  
List Type ◽  
Training Methods ◽  
Dose Frequency ◽  
Prescribing Quality ◽  
Intravenous Paracetamol

AimParacetamol is widely available and its safety profile is relatively good. However, the risk associated with a paracetamol overdose is much greater in a neonate than that associated with an adult.In 2018, 8% of paediatric medication errors related to the use of paracetamol, including three 10x overdoses. These irregular but serious risks are difficult to manage over time due to degradation of heightened awareness. The aim of this project was to improve the prescribing quality of IV paracetamol on PICU and prevent recurrence of a 10-fold overdose by the implementation of multi-level changes.MethodElectronic prescribing (EP) has been in use on our unit since 2016. Small changes (prescribing nudges) in the configuration of the EP system can be used to improve prescribing quality. Forced functions, automation and standardisation have been found to be more effective in this than more traditional education and training methods.1 2The changes implemented in January 2019 were as follows:Forced function: All paracetamol prescriptions for patients under 1 year of age were capped at 180 mg (change from 1000 mg). The prescriber could not enter a number greater than 180 mg.Automation: All oral paracetamol prescriptions were changed to automatically prescribe 15 mg/kg 6 hourly regardless of age (previously 2 different options requiring the prescriber to input dose and frequency according to formulary directions).Standardisation/simplification: All oral paracetamol prescriptions were rationalised to a single option with automatic dose and frequency as above (previously 2 different options unnecessarily).Reminder/rule: A rule of ‘Consultant Approval’ was added to all intravenous paracetamol prescriptions. The intention of this was for a review of the prescription before use to ensure appropriate use and dose/frequency. This could not be forced, so an education package was launched across the unit by the quality improvement group.Prescription details were downloaded from the EP system for 3 month periods pre and post changes. he data was audited by pharmacy undergraduate students for prescribing accuracy.ResultsThe forced function, automation and standardisation options were implemented with 100% compliance. The ‘consultant approval’ rule was followed in 23% of cases. Consultant review led to a 58.6% reduction of IV paracetamol prescriptions on the unit and zero prescriptions for the first 2 months post implementation. The usage of oral paracetamol increased accordingly. This change corresponded to an overall reduction rate of 41.7% for intravenous paracetamol prescriptions.ConclusionsThis project demonstrates how changes that increase automation within prescribing can reduce error and that implementation is more successful than education. A limitation of our data analysis was that we did not measure the effect on pain relief or pain scores in the patients who did not receive IV paracetamol compared to those who did.ReferencesCafazzo JA, et al. From discovery to design: the evolution of human factors in healthcare. Healthcare Quarterly 2012; 15: 24–29.Patel Ms, et al. Nudge units to improve the delivery of healthcare NEJM 2018; 378: 214–216.

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